Comparing the effectiveness of a group-directed video instruction versus instructor-led traditional classroom instruction for learning cardiopulmonary resuscitation skills among first-year medical students: A prospective randomized controlled study

Introduction: Bystander cardiopulmonary resuscitation (CPR) training is inconsistent among students and the public. Existing CPR teaching courses are costly, time-consuming, and inconsistent. This study aimed to determine the association between overall CPR competency and two teaching modules, a group-directed video instruction module versus an instructor-led traditional classroom instruction module. Methods: This randomized prospective interventional study involved first year medical students of Universiti Sains Malaysia Health Campus from November 2018 until January 2019. Pass-fail scores representing the overall CPR, individual skill performance, and willingness to perform CPR for strangers and family members were collected. Factors associated with reluctance to perform CPR were assessed in a questionnaire. Results: A total of 99 participants were included, 50 in the group-directed video instruction as the intervention module and 49 in the traditional classroom instruction as the control module. There was no statistical significance between the pass and fail outcomes for both video module (p=0.436). Participants in both modules performed similarly in 8 out of 12 individual CPR skills. There was a significant difference in the distribution of skill scores between the pass and fail outcomes (p=<0.001). The intervention module is non-inferior compared to the control module, in relation to CPR willingness rates for strangers (p=0.999) and family members (p=0.117) after the training. Conclusions: The group-directed video self-instruction method is as effective as the instructor-led traditional classroom method to help participants to be competent and willing to perform CPR. It can be used as an independent or supplementary teaching tool for first-time learners and refreshers, especially in a group setting when teaching materials are limited.

Very good (4 points on the Likert score) All skills were performed competently, although improvement would be possible. Errors may be minor; most were corrected. No serious errors in technique or sequence were made. CPR performed in this way is likely to be effective, and the victim would not be endangered.
Competent (3 points on the Likert score) Chest was compressed and ventilations resulted in chest rise. Skills were crude and sometimes failed to meet strict standards. Several steps may have been out of sequence. Some errors went uncorrected, although any serious errors were corrected. CPR performed in this way would probably be effective, and there would be no serious threat to the safety of the victim.
Questionably competent (2 points on the Likert score) Some chest compressions were performed, and some ventilations resulted in chest rise. Skills were crude and often failed to meet the standard: serious errors were left uncorrected. There may have been serious errors in sequence or significant delays. CPR performed in this way might be effective; errors made might seriously affect the safety of the victim.
Not competent (1 point on the Likert score) Efforts, if any, did not result in both chest rise and compression of chest. Skills were performed poorly or not at all; errors made might seriously endanger a victim. CPR performed in this way would probably not be effective, and the safety of the victim would be seriously threatened.  7. Opens airway using head-tilt/chin-lift 8. Attempts at least two breaths such that chest rises at least once and not more than twice between every set of compression.
9. Locates compression position by feeling or baring the chest and looking, as in item (5) 10. Gives at 30 compressions per cycle at the correct location for second cycle.
Compressions must result in visible depression of the sternum and complete recoil of sternum. Acceptable result is greater than 23 of 30 compressions.
11. Opens airway using head-tilt/chin-lift 12. Attempts at least 2 breaths such that chest rises at least once and not more than twice between every set of compression. RATING CHOICE 5 EXCELLENT: All skills were performed very well with no errors. CPR performed in this way is likely to be effective, and the victim would not be endangered 4 VERY GOOD: All skills were performed competently, although improvement would be possible. Errors may be minor; most were corrected. No serious errors in technique or sequence were made. CPR performed in this way is likely to be effective, and the victim would not be endangered.
3 COMPETENT: Chest was compressed and ventilations resulted in chest rise. Skills were crude and sometimes failed to meet strict standards. Several steps may have been out of sequence. Some errors went uncorrected, although any serious errors were corrected. CPR performed in this way would probably be effective, and there would be no serious threat to the safety of the victim.
2 QUESTIONABLY COMPETENT: Some chest compressions were performed, and some ventilations resulted in chest rise. Skills were crude and often failed to meet the standard: serious errors were left uncorrected. There may have been serious errors in sequence or significant delays. CPR performed in this way might be effective; errors made might seriously affect the safety of the victim. 1 NOT COMPETENT: Efforts, if any, did not result in both chest rise and compression of chest. Skills were performed poorly or not at all; errors made might seriously endanger a victim. CPR may not have been performed. CPR performed in this way would probably not be effective, and the safety of the victim would be seriously threatened.

EVALUATOR COMMENTS:
Attachment 1 to Mexmollen M, Ariff Arithra A, Junainah N, bin Tuan Hairulnizam TK, Tze Ping Pang N. If they ask questions about what they are to do with the manikin tell them to: "Check the manikin yourself and do what you think is needed to save a life."

Comparing the effectiveness of a group-directed video instruction versus instructor-led traditional classroom instruction for learning cardiopulmonary resuscitation skills among first-year medical
If they seem unsure, do your best to explain that they will be assessing the manikin and doing whatever is necessary. You can use examples, but do not tell them that they will be doing CPR.